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Tuesday, 30 April 2013

Definition:
Its a medical procedure that use in the intubation of Endotracheal tube, to see the vocal cord or glottis, It is performed by an anesthetic to give a general anesthesia, during resuscitate the patient by cardiopulmonary Resuscitation.Types of Methods:
There are following types that use for intubation;

Direct Laryngoscopy

Indirect Laryngoscopy

Fiber optic Laryngoscopy

Conventional Laryngoscopy

1. Direct Laryngoscopy:

It is performed on that patients who laying on his or her back in supine position.
It is inserted to the right side of tongue and slip it toward left side to move the tongue to out of sight.
Laryngoscope push upward and forward away from you and towards the roof.
Now you can seen epiglottis and glottis.
Perform the procedure and secure airway.
It can only perform in unconscious patients because it is slightly intact with gag reflexes.

2. Indirect Laryngoscopy:
It is performed by direct line of sight of tongue to see the vocal cord.
It is mostly performed by Fiber optic bronchoscope and video Laryngoscope etc.

3. Fiber optic Laryngoscopy:
These are the alternatives of Conventional Laryngoscope.
These are performed in the way of indirect Laryngoscope e.g; flexible fiber optic bronchoscope.

4.Conventional Laryngoscopy:
These are most popular devices use for the purpose of intubation and other anesthetic techniques.
Nowadays, Conventional Laryngoscope consists of handle that have batteries, light source, Sets of blades.

Transcutaneous pacing device also refers as External pacing device.
Some pacing devices only provide as a pacemaker.
But some of them use as a defibrillators and also as rhythm monitoring as well as pacing device.Indications of TPM;

Its is indicated as Temporary pacemaker (TPM).

It is used in the treatment of Sinus bradycardia, Symptomatic bradycardia and in AV blocks mainly.

1-Heart Rate:
QRS complex occurring once per large square is occurring at the rate of 300/min.
QRS complex occurring once per small square is occurring at the rate of 1500/min. Heart rate may be;
a- Regular
b- Irregulara-Regular heart rate:
Same or equal distance/difference between R-R interval represents the regular heart rate.How to calculate;
There are two methods to calculate the Sinus heart rate by;

By large boxes

By small boxes

1. By large boxes:
Account the large boxes between R-R interval e.g; 5 large boxes.
One large square heart rate at the rate of 300/min.
Use the formula;
300/large boxes=300/05=60 per min heart rate (HR).2. By small boxes:
Account the small boxes between R-R interval e.g; 18 small boxes.
One small square heart rate at the rate of 1500/min.
Use the formula;
1500/small square=1500/18=83 per min HR.

*Here 60/min is normal/ Rough HR.
*And 83/min is sinus/ Accurate HR.

b- Irregular heart rate:
They have no Equidistant between R-R interval of whole ECG, represents the Irregular heart rate.How to calculate;
There are two methods to calculate the irregular heart rate by;

QRS-complex take between 30 big boxes on regular ECG (Red in color)

QRS-complex take between 06 sec strip to check HR (Green in color)

1. QRS-complex take between 30 big boxes on regular ECG (Red in color):
Account 30 big boxes in an ECG starting from a QRS-complex.
Account the QRS-complex between the big 30 boxes e.g; 10 QRS-complex
Now use the formula;
QRS-complex X 10= 10 X 10= 100/min.

2. QRS-complex take between 06 sec strip to check HR (Green in color):
Account the 6 sec line on ECG paper starting from QRS-complex.
Account QRS-complex Between the 6 sec strip.
Now use the formula;
QRS-complex X 10= 6 X 10= 60/min.

* Here both methods are accurate.

2-Rhythm or Sinus Rhythm:
When the depolarization begins in the SA node of the heart, is said to be sinus Rhythm.Arrhythmia:
When the depolarization begins in the other places of the heart like Atria and ventricular the Rhythm is named after the part of the heart where the depolarization sequence originate and an Arrhythmia is said to be present.Sinus Arrhythmia:
Change in the HR associated with respiration, are normally seen in young peoples, and this is called Sinus arrhythmia.

* The rate of discharge of the SA node is influenced by he vagus nerves and reflexes originate in the lungs.

There are the six types of Rhythm:

Normal sinus rhythm

Junctional rhythm

Atrial Fibrillation

Extra-systole

Supra-ventricular tachycardia

Ventricular tachycardia

Normal Sinus Rhythm:
It contains P wave, QRS-complex and T wave with same rhythm or rate.Junctional Rhythm/Nodular:
If no P wave found its called Junctional rhythm, it is due to dysfunction of SA node and AV node that take part in depolarization.Atrial Fibrillation:
Fibrillation in the right atrium due to not proper contraction of atrium is result of many P waves found like fibrillation of right atrium.Extra-systole:
Other parts of the heart take part in depolarization like, Atrial muscles, Junctional region(AV Node) and ventricular muscles that show the ectopic beat and ectopic rhythm.

* Atrial ES have abnormal P wave shows AF.
* Junctional ES there is no P wave shows JR.Supra-ventricular tachycardia:
There is QRS-complex and P & T waves emerge in each other.Ventricular tachycardia:
It shows only QRS-complex No P waves and No T waves found.

3-Axis:
The average direction of the spread of depolarization wave through the ventricular as seen from the front is called "Cardiac Axis" Its useful to decide whether this axis can derived (direction) easily from the QRS-complex in lead I, II and III.

7-P-R Interval:
(AV delay)
Current or impulse stops at this point.
Normal: 0.12 sec- 0.2 sec i.e; 3 to 5 small square or 120ms to 200ms.
Prolonged: If P-R interval more than 5 small square, then AV node delay increases and called AV block and heart block.

8-Block bundle branch or AV blocks:
There are three types of heart block;

I degree AV block
II degree AV block

Mobitz type I

Mobitz type II

III degree AV block

I degree AV block:
P-R interval fix prolonged e.g; 7 small square.
No beat drops i.e; no drops of QRS-complex.
No any pathology rather than it.
Its called 1 degree of heart block.

II degree AV block:
There are two type of it;
Mobitz type I
Mobitz type II

Mobitz type I:

P-R interval progressively prolonged e.g; more than 5,6,7,8 and so on.
Beat drops i.e; drops QRS-complex.
Pulse is irregular clinically.
Its also known is Wenchebach's phenomenon.

Mobitz type II:

P-R interval fix prolonged e.g; 7 small square.
Beat drops i.e; drops QRS-complex, e.g; more P waves than QRS-complex.
Its not due to lengthening of AV conduction time, its usually due to block within bundle of His.
Its mostly due to organic heart disease.
Its lead to complete heart block.

III degree AV block:
Its also known as complete heart block, i.e; no impulse from atria to ventricular reaches.
Its only maintained by escape Rhythm, i.e; arising from bundle of His (narrow QRS-complex at the rate of 50 to 60 bpm), Below the bundle of His (make broad complexes at the rate of 15 to 40 bpm)
Exertion or Exercise does not increase the heart rate.

9-Q Wave:
-Small septal Q wave are normal in lead I, AVL and V6.
-Its can also seen in lead III but in AVF is not a normal variant.
-Probably indicates infarction, If MI present in more than one lead i.e; more than 2 or more leads, longer than 40 ms in duration and deeper than 2 mm in amplitude.
-Q wave in lead III (but not in AVF) pulse Right axis deviation may indicates "Pulmonary embolism".
-Leads showing Q waves indicates the site of infarction.
i.e;

Definition:
A Conventional Defibrillator (DC) is used as a Defibrillator that use in Hospitals to treat the cardiac arrhythmia, cardiac arrest, Ventricular tachycardia (pulse-less) or Ventricular fibrillation.

Method:How to use the DC?
1-It can only use by that person who have experience in ECG monitoring and Recognition.
2-Remove the patient from metallic body or bed
3-Make the patient position, it can be supine or decubitus.
4-Expose the patient chest, Remove contaminated things like; wet, metal etc
5-Prepare the DC, attach the batteries, attach the paddle with DC.

6-Place the paddle on patient chest; in supine or decubitus position.

In Supine; one paddle place to the right side just below to the clavicular bone and above nipple line, second place to the left side at anterior axillary line.

In decubitus; one paddle place to the left side just below the clavicular bone, second place to the back below shoulder blade in right lateral position.

7-Now check again DC connection, Make sure that all wires are attached.

8-Provide the Electric shock to the patient when needed, otherwise continue CPR.

Definition:
Automated External Defibrillator is a portable or easy to use device that checks the heart rhythm. In use it can send an electrical shock to the heart to treat the cardiac arrest and normalize the heart rate.Uses of AED:
Conditions in which an Automated external Defibrillator is used;

* If unresponsive
Call to EMS
Check ABC (Airway, Breathing, Circulation)
Start CPR
Use AEDMethod:
How to use an Automated External Defibrillator?
1-An untrained person can easily use an automated external defibrillator.
2-Remove the patient from contaminated area make sure patient's and your safety.
3-Expose the patient chest, remove all contaminated things from the chest like; jewelry, metals, wet, heavy hair etc
4-Prepare the AED as turn on it, attach the sticky electrodes with AED machine, make the patient's position as supine, apply the pads as;

a) place one pad on right side just below to the clavicular bone and above to the nipple.
b) place second pad on left side in anterior axillary line at the apex beat position.

5-Make sure patient have not any medication bracelet or neck-less that alert the patient disease.
6-If patient is on PPM (permanent pace maker) then you should need to place pads 1 inch away from its wires.
7-Make Sure that no one touching ti the patient.
8-Recheck again AED preparation, then follow these steps;